Samen beslissen met ROM als informatiebron:Kwalitatief onderzoek onder cliënten

Achtergrond Acht ggz-organisaties hebben in de periode 2019-2022 gewerkt aan de doorontwikkeling en implementatie van ‘Samen beslissen met routine outcome monitoring (ROM) als informatiebron’.Doel Inzicht krijgen in behoeften en ervaringen van cliënten met samen beslissen en ROM, en onderzoeken welke implementatieaanpak dit vraagt.Methode Exploratief, kwalitatief onderzoek bestaande uit semigestructureerde interviews en focusgroepen met cliënten (n = 101) in behandeling bij ggz-organisaties verspreid over Nederland.Resultaten Cliënten vonden samen beslissen belangrijk. Voor een goede toepassing vonden zij generieke aspecten (luisteren, vertrouwen, volledige informatie en gelijkwaardige inbreng) én maatwerk (aansluiten bij hulpvraag en bij elk besluit metacommunicatie over de rolverdeling tussen cliënten, naaste(n) en behandelaren, en wijze van informatievoorziening) van belang. Cliënten waardeerden ROM als informatiebron bij samen beslissen, mits vragenlijsten niet te lang waren, aansloten bij de problematiek en uitkomsten besproken werden.Conclusie Samen beslissen met ROM is in de ggz nog niet breed geïmplementeerd. Dit vraagt een blijvende stimulans en evaluatie ervan. De toepassing kan verbeteren door (na)scholing van behandelaren en ondersteuning van cliënten met betrokkenheid van naaste(n), ervaringsdeskundigen en psycho-educatie. Cliënten waarderen ROM als hulpmiddel bij samen beslissen; inzage in de eigen ROM is hierbij nuttig

Distress and quality of life after autologous stem cell transplantation: a randomized clinical trial to evaluate the outcome of a web-based stepped care intervention

Background Psychological distress (i.e. depression and anxiety) is a strong predictor of functional status and other aspects of quality of life in autologous stem cell transplantation following high-dose chemotherapy. Treatment of psychological distress is hypothesized to result in improvement of functional status and other aspects of quality of life. The aim is to evaluate the outcome of stepped care for psychological distress on functional status and other aspects of quality of life in patients with hematological malignancy treated with autologous stem cell transplantation. Methods/Design The study is designed as a randomized clinical trial with 2 treatment arms: a stepped care intervention program versus care as usual. Patients are randomized immediately pre transplant. Stepped care and care as usual are initiated after a 6 weeks buffer period. Outcome is evaluated at 13, 30, and 42 weeks post transplant. In the experimental group, the first step includes an Internet-based self-help program. If psychological distress persists after the self-help intervention, the second step of the program is executed, i.e. a diagnostic evaluation and a standardized interview, yielding a problem analysis. Based on this information, a contract is made with the patient and treatment is provided consisting of individual face-to-face counseling, medication, or referral to other services. Care as usual comprises an interview with the patient, on ad hoc basis; emotional support and advice, on ad hoc basis; if urgent problems emerge, the patient is referred to other services. Primary outcome variables are psychological distress and functional status. Data are analyzed according to the intention to treat-principle. Discussion This study has several innovative characteristics. First, the outcome of the intervention for psychological distress in patients with hematological malignancy treated with autologous stem cell transplantation is evaluated in a randomized controlled study. Second, the impact of the intervention on functional status is evaluated: it is hypothesized that reduction of psychological distress results in improved functional status. Furthermore, the intervention concerns an Internet-based treatment in the first step. Finally, the intervention is characterized by an emphasis on self-management, efficiency, and a multi-disciplinary approach with nurses taking up a central role

Medical students' cases as an empirical basis for teaching clinical ethics

Purpose. To identify ethical issues that interns encounter in their clinical education and thus build a more empirical basis for the required contents of the clinical ethics curriculum. Method. The authors analyzed a total of 522 required case reports on ethical dilemmas experienced by interns from September 1995 to May 1999 at the medical school of Vrije Universiteit in Amsterdam. They identified four regularly described and numerous less frequently described topics. Results. The interns addressed a wide range of ethical themes. In 45% of the cases, they mentioned disclosure or non-disclosure of information and informed consent; in 37%, medical decisions at the end of life; in 16%, medical failures; and in 9%, problems transferring patients from one caregiver to another. The interns also identified 27 themes linked to their unique position as interns and 19 themes related to specific types of patients. Conclusion. Based on self-reported experiences, the authors conclude that clinical ethics teachers should reflect on a multitude of dilemmas. Special expertise is required with respect to end-of-life decisions, truth telling, medical failures, and transferring patients from one caregiver to another. The clinical ethics curriculum should encourage students to voice their opinions and deal with values, responsibilities, and the uncertainty and failings of medical interventions

Identifying value-based quality indicators for general hospital psychiatry

Objective: To define generic quality indicators for general hospital psychiatry from the perspectives of patients, professionals (physicians, nurses, and managers), and payers (health insurance companies). Methods: Quality variables were identified by reviewing the relevant literature. A working. group consisting of patients', professionals' and payers' representatives was mandated by their respective umbrella organizations. The working group prioritized the quality variables that were identified. Core values were defined and subsequently linked to preliminary quality indicators. These were tested for feasibility in ten hospitals in a four-week period. Stakeholder consultation took place by means of two invitational conferences and two written commentary rounds. Results: Forty-one quality variables were identified from the literature. After prioritization, seven core values were defined and translated to 22 preliminary indicators. Overall, the feasibility study showed high relevance scores and good implementability of the preliminary quality indicators. A final set of twenty-two quality indicators (17 structure, 3 process and 2 outcome indicators) was then established using a consensus-based approach. Conclusion: Consensus on a quality framework for general hospital psychiatry was built by incorporating the perspectives of relevant stakeholders. Results of the feasibility study suggest broad support and good implementability of the final quality indicators. Structural indicators were broadly defined, and process and outcome indicators are generic to facilitate quality measurement across settings. The quality indicator set can now be used to facilitate quality and outcome assessment, stimulate standardization of services, and help demonstrate (cost-) effectiveness